We report a healthy, 73-year-old Japanese woman who presented with primary cryptococcosis on the skin of both cheeks. She had initially developed an erythematous, partly ulcerated lesion on the right cheek 2 weeks earlier following an injury. There was no regional lymphadenopathy, and chest X-rays were normal. Histopathological findings showed granulomatous cell infiltration. Periodic acid Schiff staining revealed spores that were identified by the indirect immunoperoxidase staining method as Cryptococcus neoformans. The isolate was identified as C. neoformans var. neoformans serotype D. The skin lesions healed in 1 month without antifungal therapy. A literature review indicates that this serotype tends to produce cutaneous lesions without systemic involvement.
With use of an immunoblot assay for both the normal human epidermal extracts and the bovine desmosome preparation, we investigated sera from 18 patients with pemphigus, who exhibited atypical clinical or histologic features and whose diagnoses were difficult to identify. Four sera yielded a 130-kd protein band in the epidermal extracts, which is characteristic of pemphigus vulgaris. A 150-kd protein was identified by nine sera in the epidermal extracts and/or the desmosome preparation, which is known as a pemphigus foliaceus antigen. Five sera demonstrated neither antigen. These results suggest that the immunoblot technique is useful to distinguish pemphigus vulgaris from pemphigus foliaceus and can be a good tool for the diagnosis of pemphigus, especially unclassified cases.
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